Altitude Headache: Causes, Symptom and Treatment

Altitude Headache Summary

Summary

  1. Altitude headache occurs due to low oxygen levels, typically above 2,500 meters.
  2. Common symptoms include bilateral throbbing pain, nausea, and fatigue.
  3. Treatment involves gradual ascent, pain relievers, and oxygen supplementation if severe.

Introduction

Altitude headache happens when people go to high places, usually over 2,500 meters (8,200 feet). This height has less oxygen and lower air pressure, which can cause discomfort and various body responses.

This headache is a main sign of acute mountain sickness (AMS) and is a common issue for those at high altitudes. Altitude headache is usually not serious and goes away with proper adjustment or moving to a lower height.

Still, it may sometimes signal more severe altitude-related problems, like high-altitude cerebral edema (HACE), which can be dangerous.

The International Headache Society (IHS) recognizes altitude headache as a separate condition. It starts within 24 hours of going up, often going away within eight hours of coming down. Understanding its causes, signs, and treatment is crucial for those planning trips to high places.

Causes

The main cause of altitude headache is being at high altitudes where the air has less pressure and oxygen (hypoxia). This lack of oxygen triggers bodily responses that can lead to headaches and other symptoms of altitude sickness. Key reasons for altitude headache include:

  1. Hypoxia and Increased Blood Flow: With less oxygen, the body dilates blood vessels to get more blood to the brain, raising pressure in the head, which can cause headaches.
  2. Fluid Issues: Hypoxia can mess with fluid balance in the brain, leading to swelling, which may also cause headaches.
  3. Slow Adjustment: If the body doesn’t adjust well to the lower oxygen at high places, symptoms including headaches can get worse.
  4. Physical Activity: Exercise at high altitudes adds stress on the body and can make headache symptoms worse due to higher oxygen needs and low oxygen levels.

Symptoms

Altitude headache usually has the following features:

  1. Throbbing Pain: The headache is often two-sided and thumping, like a tension headache or migraine.
  2. Location: Pain often occurs in the forehead or temples but can also feel spread out.
  3. Activity Impact: Physical effort, especially at high altitude, can make the headache worse.
  4. Duration: Symptoms usually start six to twelve hours after reaching altitude and may last until the body adjusts or the person descends.
  5. Other Symptoms: Those with altitude headache may also have AMS symptoms like nausea, dizziness, tiredness, trouble sleeping, and less appetite.

Risk Factors

Multiple factors can increase the chance of altitude headache and related issues:

  1. Speed of Ascent: Climbing too quickly without enough adjustment time raises the risk of headaches.
  2. Height Reached: The higher the place, especially above 2,500-3,000 meters (8,200-9,800 feet), the higher the headache risk due to less oxygen.
  3. Past Altitude Sickness: Those who have had altitude sickness before are more likely to get altitude headaches.
  4. Physical Activity at Height: Vigorous exercise at high places raises oxygen needs and the risk of headaches.
  5. Dehydration: High areas are usually dry, and not drinking enough can worsen headache symptoms.
  6. Poor Adjustment: People who aren’t used to high places have a greater chance of altitude headaches.

Differential Diagnosis

Altitude headache shares symptoms with other conditions that must be identified for suitable treatment:

  1. Migraine: Migraines can be triggered or made worse by altitude. A history of migraines and symptoms like aura also play a role. response to migraine drugs can help tell it apart from headache caused by high altitude.
  2. Tension-Type Headache: Tension headaches might look like altitude headaches because they affect both sides, but they don’t usually happen with altitude changes and can have different causes like stress.
  3. High-Altitude Cerebral Edema (HACE): HACE is a serious type of altitude sickness where headaches come with confusion, loss of coordination, and changes in awareness. It is an emergency that needs quick descent.
  4. Sinusitis: Headaches from sinus blockage, especially in dry and cold conditions, can seem like altitude headaches but may involve facial pain, nasal blockage, and may get worse with head movements.
  5. Dehydration Headache: Lack of fluids at high altitudes can cause headaches, but they typically get better with rehydration and don’t show other altitude sickness signs.
Comparison Table
Differential Diagnosis Definition Symptoms Treatment
Altitude Headache A headache caused by low oxygen levels at high altitudes, typically above 2,500 meters. Dull, throbbing pain, usually bilateral, associated with nausea and fatigue. Gradual ascent, acetaminophen or ibuprofen, and oxygen supplementation if severe.
Migraine A neurological condition often triggered by altitude, stress, or certain foods. Unilateral, throbbing pain often with aura, nausea, and sensitivity to light and sound. Triptans, NSAIDs, and preventive measures like avoiding triggers.
Tension-Type Headache Common headache caused by muscle tension or stress. Bilateral, pressing or tightening pain; not aggravated by physical activity. Stress management, analgesics, and relaxation techniques.
High-Altitude Cerebral Edema (HACE) A severe altitude sickness involving brain swelling due to low oxygen. Severe headache, confusion, loss of coordination, and altered consciousness. Immediate descent, oxygen therapy, and dexamethasone.
Sinusitis Inflammation of the sinuses, often mimicking headache symptoms. Facial pain, nasal congestion, and headache worsened by head movements. Decongestants, nasal irrigation, and antibiotics if bacterial.
Dehydration Headache A headache caused by insufficient hydration, common at high altitudes. Diffuse, non-pulsating pain; improves with hydration. Rehydration with water or electrolyte solutions.

Investigation

Altitude headache is mostly identified based on clinical history and symptoms since there are no specific tests for it. Investigations aim to rule out other headache causes and assess the severity of altitude sickness. Important checks include:

  • Clinical History and Symptom Review: A careful look at symptoms, altitude reached, ascent speed, and the individual’s altitude exposure history helps confirm the altitude headache diagnosis.
  • Physical Examination: Checking for other altitude sickness symptoms like confusion, loss of coordination, or lung sounds (to eliminate high-altitude lung edema) is important.
  • Pulse Oximetry: A simple, non-invasive test to check oxygen saturation levels that may be lower at high altitudes due to low oxygen.
  • Cognitive and Neurological Evaluation: Tests for coordination, balance, and mental clarity are helpful if HACE is suspected, as it is more severe than altitude headache.

In serious cases or when problems are suspected, especially in remote high-altitude areas, descent and medical facility evaluation are advised.

Treatment

Treating altitude headache focuses on relieving symptoms, adapting to altitude, and preventing more severe altitude illnesses. Treatment options include:

1. Immediate Measures

  • Descent: Going to a lower altitude is the best way to ease altitude headache and other altitude sickness symptoms. Even moving down a few hundred meters can help.
  • Rest: Cutting down on physical activity lowers oxygen need, helping the body adapt and easing headache symptoms.
  • Hydration: Staying hydrated is crucial, as high altitudes can lead to quick dehydration, worsening headache symptoms.

2. Medications

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drugs like ibuprofen or aspirin are often used to relieve altitude headache pain. Studies show that ibuprofen is particularly effective for altitude-related headache symptoms.
  • Acetaminophen: For those who cannot take NSAIDs, acetaminophen can relieve pain without the gastrointestinal issues linked to NSAIDs.
  • Acetazolamide (Diamox): This drug speeds up adaptation by causing a mild metabolic acidosis, which boosts breathing and improves oxygen levels. Acetazolamide can be used as a preventive measure before going up or to treat mild symptoms.
  • Dexamethasone: This corticosteroid decreases brain swelling and is usually intended for more serious altitude sickness symptoms. It should be taken under medical advice due to possible side effects and is especially useful for HACE symptoms.
  • Oxygen Therapy: Extra oxygen can quickly relieve altitude headache and other altitude sickness symptoms. Portable oxygen devices may be needed in serious cases, especially if descent isn’t possible right away.

3. Preventive Measures

For people looking to go to high altitudes, There are some ways to prevent altitude headache:

  • Slow Ascent: Going up slowly helps the body adjust, which lowers the chances of getting an altitude headache. It is usually advised not to sleep more than 300-500 meters (1,000-1,600 feet) higher each night after reaching 2,500 meters (8,200 feet).
  • Pre-Acclimatization: Spending time at middle altitudes before going higher can aid the body in adapting to less oxygen gradually.
  • Medication Use: Taking acetazolamide can help prevent altitude headache and assist with acclimatization, especially for those who have had altitude sickness before.
  • Avoiding Alcohol and Sedatives: Alcohol and sedatives can slow down breathing and make hypoxia worse at high altitude. It’s best to avoid these when climbing and at high elevations.
  • Stay Hydrated: Drinking enough water is important to fight off the dehydrating effects of high altitude and to avoid headaches related to dehydration.

Complications

While altitude headache typically goes away on its own, ignoring it can be a sign of more serious altitude-related issues. Complications include:

  • High-Altitude Cerebral Edema (HACE): If an altitude headache is severe and is also accompanied by confusion, unsteady movements, or changes in mental state, it may mean HACE, which is a serious condition needing urgent descent and medical help.
  • High-Altitude Pulmonary Edema (HAPE): HAPE is another serious problem at high altitude that shows up as shortness of breath, tightness in the chest, and coughing. It can be deadly if not treated, requiring quick descent.
  • Chronic Altitude Sickness: In rare situations, people who stay at high elevations for long periods may get chronic altitude sickness, which causes ongoing low oxygen levels and related issues.

Conclusion

Altitude headache is a frequent and often manageable issue at high altitudes. It mainly comes from low oxygen levels and other body changes when there is less oxygen.

Knowing the reasons, risk factors, and prevention methods is important for anyone planning to go to high altitudes. Treatments include going down in altitude, resting, staying hydrated, and using medications like NSAIDs, acetazolamide, or oxygen therapy.

If symptoms persist or are severe, quick medical help may be needed, as altitude headache can sometimes signal the start of high-altitude cerebral edema, a serious condition.

By following preventive steps and acting quickly on symptoms, the dangers of altitude headache can be reduced, leading to a safer and better experience at high altitudes.

References
  1. Basnyat B, Murdoch DR. “High-altitude illness.” The Lancet. 2003;361(9373):1967-1974.
  2. Hackett PH, Roach RC. “High-altitude illness.” New England Journal of Medicine. 2001;345(2):107-114.
  3. Imray C, Wright A, Subudhi A, Roach R. “Acute mountain sickness: pathophysiology, prevention, and treatment.” Progress in Cardiovascular Diseases. 2010;52(6):467-484.
  4. Bartsch P, Swenson ER. “Clinical practice: Acute high-altitude illnesses.” New England Journal of Medicine. 2013;368(24):2294-2302.
  5. International Headache Society. “The International Classification of Headache Disorders, 3rd edition.” Cephalalgia. 2018;38(1):1-211.
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